Provider Demographics
NPI:1497972392
Name:PARKER, JOHN CHARLES
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 BLACK WATCH LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8015
Mailing Address - Country:US
Mailing Address - Phone:757-479-9120
Mailing Address - Fax:757-494-1721
Practice Address - Street 1:2040 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3004
Practice Address - Country:US
Practice Address - Phone:757-543-9632
Practice Address - Fax:757-494-1721
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist